Medications for Schizophrenia

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medication seems to improve the long-term outcome for most people with schizophrenia. After 10 years of drug treatment, 25% of people with schizophrenia completely recover, 25% experience considerable improvement, and 25% experience modest improvement.

It is important for people with schizophrenia to continue with their drug treatment, even after recovery from an acute episode. The one-year relapse rate is about 80% for those who stop taking their medications after an acute episode. For those who continue to take their medications, the one-year relapse rate is only about 30%.

Prescription Medications

Neuroleptics

Neuroleptics remain the treatment of choice for schizophrenia. They are divided into 2 separate classes, typical antipsychotics, which are the older and less expensive medications, and atypical antipsychotics, which are newer and more expensive.

It is important to understand that there are risks and benefits with every medication. Patients may need to try more than one drug or combine medications to get the right treatment.

Typical (First Generation) Antipsychotics

Common names include:

Chlorpromazine

Fluphenazine

Haloperidol

Perphenazine

Thioridazine

Thiothixene

Trifluoperazine

Typical antipsychotics are often very effective in treating certain symptoms (commonly referred to as positive symptoms) of schizophrenia, particularly hallucinations and delusions. Unfortunately, they may not be as helpful with other symptoms (known as negative symptoms), such as reduced motivation, apathy, and a lack of emotional expressiveness.

Typical antipsychotics can produce side effects that resemble the more difficult to treat negative symptoms. Often, lowering the dose or switching to a different medication may reduce these side effects. Patients may have difficulty complying with these medications as they may produce significant side effects.

Gynecomastia—the appearance of breast tissue in males unrelated to weight

Difficulty with urination

Many of these side effects can often be corrected by lowering the dosage or controlled by the addition of other medications. Patients may have unique responses and experience different side effects to various antipsychotic drugs.

A possible, serious, long-term side effect with any typical antipsychotic is
tardive dyskinesia
(TD). TD is a disorder characterized by involuntary movements, most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs.

In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements. When the symptoms are severe, though, they can be disconcerting to both the patient and others. In this case, the patient may be switched to a different antipsychotic. The course of TD is extremely variable. If detected early, the chance of the side effect becoming milder or disappearing is greatly increased. Unfortunately, for many patients, the abnormal movements seen in TD are permanent.

Atypical (Second Generation) Antipsychotics

Common names include:

Aripiprazole

Asenapine

Brexipiprazole

Cariprazine

Clozapine

Iloperidone

Lurasidone

Olanzapine

Paliperidone

Quetiapine

Risperidone

Ziprasidone

Atypical antipsychotics are equally effective in treating the positive symptoms of schizophrenia, such as hallucinations and delusions. Unlike typical antipsychotics, atypical antipsychotics may also treat the negative symptoms of schizophrenia, such as apathy, listlessness, restlessness, and social withdrawal. There is some evidence that some atypical antipsychotics are effective at treating
depression.

Atypical antipsychotics tend to have fewer dyskinetic side effects than typical psychotics. It may take several weeks to months before atypical antipsychotics produce the desired treatment effects. There is recent evidence to suggest that this type of medication can produce a significant amount of weight gain (with the exceptions of ziprasidone and aripiprazole). Atypical antipsychotics also have been linked to the development of
diabetes cholesterol, and
metabolic syndrome.

Clozapine, the first atypical antipsychotic developed, is a very effective treatment for schizophrenia. The drug's use has been limited because approximately 1% of individuals who take it will develop a life threatening side effect called
neutropenia
(a severe decrease in the white blood cell count), which can make one highly susceptible to developing infections. Clozapine is only used if a patient has not responded to 2 adequate trials of other antipsychotics. Any patient taking clozapine is required to have their blood drawn weekly in order to monitor white blood cell counts.

Tardive dyskinesia (The exact risk of developing TD with the use of atypical antipsychotics has not yet been determined.)

Shared Side Effects

Antipsychotic medications, in rare cases, can cause a condition called neuroleptic malignant syndrome (NMS). This life-threatening condition can occur in up to 1% of people taking these medications. It typically occurs within the first 2 weeks of treatment, but can occur later. Symptoms include fever, sweating, muscle stiffness, and lightheadedness. This condition requires immediate medical care.

Special Considerations

Compliance with medication tends to be a problem in people with schizophrenia for a variety of reasons. Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including haloperidol, fluphenazine, perphenazine, risperidone, and others, are available in long-acting injectable forms that eliminate the need to take pills every day.

Medication calendars or pillboxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication with routine daily events like meals, can help patients remember and adhere to their dosing schedule. Encouraging family members to actually observe daily medication intake can greatly increase adherence. In addition, to these adherence strategies, patient and family education about schizophrenia is an important part of any successful treatment process.

When to Contact Your Doctor

Contact a doctor if the patient experiences any unwanted and/or persistent side effects, or if you feel that the patient is not improving with the prescription medications.

Precautions

If you are taking medications, follow these general guidelines:

Take the medication as directed. Do not change the amount or the schedule.

Ask what side effects could occur. Report them to your doctor.

Talk to your doctor before you stop taking any prescription medication.

Do not share your prescription medication.

Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.

Plan ahead for refills as needed.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.